Die onkologische Versorgung von Brustkrebspatientinnen mit vorbestehender Behinderung – Ergebnisse einer qualitativen Studie über wahrgenommene Barrieren, kommunikative Schwierigkeiten und Bedarfe

Zusammenfassung

Menschen mit Behinderung finden im Hinblick auf ihre individuellen Bedürfnisse bislang wenig Berücksichtigung in der Gesundheitsversorgung. Die Studie erhebt die Innenperspektive von Brustkrebspatientinnen mit einer vorbestehenden Behinderung in Bezug auf Bedarfe und Barrieren in der onkologischen Versorgung. Hierzu wurden qualitative, leitfadengestützte Interviews geführt und mittels qualitativer Inhaltsanalyse ausgewertet. Eingeschlossen wurden 23 Patientinnen mit körperlichen Behinderungen, chronischen körperlichen Erkrankungen, Sinnesbehinderungen, psychischen Erkrankungen und/oder geistiger Behinderung. In Abhängigkeit von der Art der Behinderung standen für Patientinnen unterschiedliche Barrieren im Vordergrund. Um die von Menschen mit Behinderung erlebten Barrieren in der Versorgung abzubauen, ist es notwendig, die Kooperation von Versorgenden aus verschiedenen Versorgungsbereichen zu fördern sowie Versorgende im Umgang mit Menschen mit Behinderung zu schulen.

Abstract

Up to now, people with disabilities have received little consideration in health care with regard to their individual needs. This study gathers information on the internal perspective of breast cancer patients with a pre-existing disability with regard to needs and barriers in oncological care. For this purpose, qualitative, guideline-based interviews were conducted and analysed using qualitative content analysis. Twenty-three patients with physical disabilities, chronic physical illnesses, sensory disabilities, mental illnesses and/or intellectual disabilities were included. Depending on the type of disability, patients faced different barriers. In order to reduce the barriers experienced by people with disabilities in care, it is necessary to promote cooperation between care providers from different care sectors and to train care providers in dealing with people with disabilities.

Schlüsselwörter

Patientenperspektive - Qualitative Forschung - Brustkrebs - Behinderung - Versorgungsforschung - Barrieren

Key words

patient perspective - qualitative research - breast cancer - disability - health services research - barriers

• Literatur

• 1 United Nations: Übereinkommen über die Rechte von Menschen mit Behinderungen (2006). Im Internet: https://www.behindertenrechtskonvention.info/uebereinkommen-ueber-die-rechte-von-menschen-mit-behinderungen-3101/; Stand: 15.12.2020
• 2 Reichard A, Stolze H, Fox MH. Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disability and Health Journal 2011; 4: 59-67
• 3 Willis DS. What influences women with intellectual disabilities to attend breast screening? Experiences of women who have and have not participated. British Journal of Learning Disabilities 2016; 44: 269-276
• 4 Hasseler M. Menschen mit geistigen und mehrfachen Behinderungen als vulnerable Bevölkerungsgruppe in gesundheitlicher Versorgung. Dtsch Med Wochenschr 2014; 139: 2030-2034
• 5 Truesdale-Kennedy M, Taggart L, Mcllfatrick S. Breast cancer knowledge among women with intellectual disabilities and their experiences of receiving breast mammography. Journal of Advanced Nursing 2011; 67: 1294-1304
• 6 Satgé D, Sauleau EA, Jacot W. et al. Age and stage at diagnosis: a hospital series of 11 women with intellectual disabilities and breast carcinoma. BMC Cancer 2014; 14: 150
• 7 Robert Koch-Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Krebs in Deutschland für 2013/2014. 11. Ausgabe. Berlin, 2017
• 8 United Nations: Ageing and Disability. Im Internet: https://www.un.org/development/desa/disabilities/disability-and-ageing.html; Stand: 18.06.2022
• 9 Groß SE, Pfaff H, Swora M. et al. Health disparities among breast cancer patients with/ without disabilities in Germany. Disability and Health Journal 2019; 13: 100873
• 10 Iezzoni LI, Kilbridge K, Park ER. Physical access barriers to care for diagnosis and treatment of breast cancer among women with mobility impairments. Oncology Nursing Forum 2010; 37: 711-717
• 11 Horner-Johnson W, Dobbertin K, Lee JC. et al. Disparities in health care access and receipt of preventive services by disability type: Analysis of the medical expenditure panel survey. Health Services Research 2014; 49: 1980-1999
• 12 Iezzoni LI, Ngo LH, Li D. et al. Early stage breast cancer treatments for younger medicare beneficiaries with different disabilities. Health Services Research 2008; 43: 1752-1767
• 13 Kuckartz U. Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstützung. Weinhein: Beltz, Juventa; 2018
• 14 Edwards DJ, Sakellariou D, Anstey S. Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: a mixed methods systematic review. Disabil Health J 2020; 13: 100844
• 15 Hasseler M. Menschen mit geistigen und mehrfachen Behinderungen in der akut-stationären Versorgung. Ausgewählte Ergebnisse einer qualitativ-explorativen Untersuchung. Dtsch Med Wochenschr 2015; 140: e217-e223
• 16 Björk Brämberg E, Torgerson J, Norman Kjellström A. et al. Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care. BMC Fam Pract 2018; 19: 1-11
• 17 Kroll T, Jones GC, Kehn M, Neri MT. Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry. Health & Social Care in the Community 2006; 14: 284-293
• 18 Kohn L, Christiaens W, Detraux J, De Lepeleire J, De Hert M, Gillain B. et al. Barriers to somatic health care for persons with severe mental illness in Belgium: a qualitative study of patients’ and healthcare professionals’ perspectives. Front Psychiatry 2021; 12: 798530